Let’s say you own or work on one of the thousands of farms right here in North Carolina doing tough and honest work. Unfortunately, that tough and honest work is seasonal and doesn’t afford you a private health plan. But what that tough and honest work does provide you is a nagging back injury that eventually progresses into debilitating pain and an addiction to illegally obtained pain pills.
Of course, this situation is entirely hypothetical—but it probably happens more often than you might suspect. And it’s for reasons like this—and for people like our farmer example—that the Secretary of the North Carolina Department for Health and Human Services wants to expand Medicaid.
In the latest edition of the NC Coalition for Fiscal Health’s podcast, “The Cost of Health,” we talked to Dr. Mandy Cohen about her background in healthcare, the number of uninsured North Carolinians, and her ideas to bridge the coverage gap.
Public policy, particularly within the managed healthcare space, is not a new concept for Secretary Cohen. Prior to her appointment with the state in January 2017, Cohen spent years working for the Centers for Medicare and Medicaid Services (CMS). At the time of her departure, she was the bureau’s Chief Operating Officer and Chief of Staff.
But throughout her time at CMS, and even in the early stages of her career as a physician, Cohen had a keen interest in access to care and driving toward a healthier society.
Since Medicaid is insurance that’s intended for people with lower incomes, it sometimes carries a negative reputation or association. Despite the stigma, Cohen cautions that the majority of its members are either children (1.2 million in North Carolina), those with disabilities, or seniors.
But then there are the people like our farmer or those who fall into what’s called the “coverage gap.” This is when someone makes too much money to be eligible for Medicaid, but not enough to qualify for a subsidy under the Affordable Care Act (ACA).
Cohen’s proposed plan to close that gap is through expansion and following what almost 40 other states have done in drawing down $4 billion in federal funds and grants to provide more North Carolinians with access to care. According to Cohen, this move could result in 500,000 more state residents gaining insurance coverage.
As part of this disbursement of funds, the federal government requires that recipient states must put up 10% of the money. However, Cohen’s plan makes it clear that this money would not come from the residents or through any sort of state tax. Instead, the hospitals and health plans would be the ones assessed to cover the required funds.
While this is good news all around for North Carolinians since more people would have access to care and the funds wouldn’t require an additional tax, Cohen argues that it should be good news to the hospitals and health plans too. Both of those groups stand to benefit financially from an influx of newly insured residents.
While the expansion of Medicaid is still under discussion, one change that is already in the works is having private insurance companies administer the plan on behalf of the state. While the state has historically been the one to oversee the program, those with North Carolina Medicaid plans could have a United or Blue Cross NC plan within the next year or so.
Cohen also told us that she does not see the state moving toward a single-payer healthcare system in the near future. With any change the state makes as it relates to our residents’ healthcare, Cohen stressed that she’s all for a pragmatic approach with no sharp turns. She recognizes that people have an allegiance to their healthcare providers and doesn’t want to do anything that could impair or sever that relationship.
Ultimately, Cohen said, her goal for the Medicaid program is to bring in the best of what’s used in other states to meld with what we’re doing right in North Carolina. As part of that process, she intends to get coverage for more people and get more value out of every dollar spent by the state.
If you have a story to share about the impact of healthcare costs on your family or business, let us know at firstname.lastname@example.org on twitter @michaelck.
Past (and future) episodes of our podcast “The Cost of Health” are available for download. Visit here, or listen and subscribe on your favorite podcast app.
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